Journal article
2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging
Arthritis care & research (2010), Vol.74(4), pp.505-520
03/01/2022
DOI: 10.1002/acr.24839
PMCID: PMC10231687
PMID: 35233989
Abstract
To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype.
We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations.
Recommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well-balanced, age-appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision-making with patients/caregivers. Disease management for all patients with JIA is addressed with respect to nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional.
This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis, and a concurrent 2021 guideline on oligoarthritis, temporomandibular arthritis, and systemic JIA. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
Details
- Title: Subtitle
- 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging
- Creators
- Karen B Onel - Hospital for Special SurgeryDaniel B Horton - Rutgers, The State University of New JerseyDaniel J Lovell - Cincinnati Children's Hospital Medical CenterSusan Shenoi - University of WashingtonCarlos A Cuello - McMaster UniversitySheila T Angeles-Han - Cincinnati Children's Hospital Medical CenterMara L Becker - Duke UniversityRandy Q Cron - University of Alabama at BirminghamBrian M Feldman - University of TorontoPolly J Ferguson - University of IowaHarry Gewanter - Virginia Commonwealth UniversityJaime Guzman - Case Western Reserve UniversityYukiko Kimura - Hackensack University Medical CenterTzielan Lee - Stanford UniversityKatherine Murphy - Louisiana Department of Health, New Orleans.Peter A Nigrovic - Brigham and Women's HospitalMichael J Ombrello - National Institute of Arthritis and Musculoskeletal and Skin DiseasesC Egla Rabinovich - Duke UniversityMelissa Tesher - University of ChicagoMarinka Twilt - Alberta Children's HospitalMarisa Klein-Gitelman - Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois.Fatima Barbar-Smiley - Nationwide Children's HospitalAshley M Cooper - Children's Mercy HospitalBarbara Edelheit - Children's Medical CenterMiriah Gillispie-Taylor - Baylor College of MedicineKimberly Hays - Penn State Milton S. Hershey Medical CenterMelissa L Mannion - University of Alabama at BirminghamRosemary Peterson - Children's Medical CenterElaine Flanagan - Emory UniversityNadine Saad - University of MichiganNancy Sullivan - ECRI InstituteAnn Marie Szymanski - Johns Hopkins All Children's HospitalRebecca Trachtman - Icahn School of Medicine at Mount SinaiMarat Turgunbaev - American CollegeKeila Veiga - Boston Children's HospitalAmy S Turner - American College of RheumatologyJames T Reston - ECRI Institute
- Resource Type
- Journal article
- Publication Details
- Arthritis care & research (2010), Vol.74(4), pp.505-520
- DOI
- 10.1002/acr.24839
- PMID
- 35233989
- PMCID
- PMC10231687
- NLM abbreviation
- Arthritis Care Res (Hoboken)
- eISSN
- 2151-4658
- Language
- English
- Date published
- 03/01/2022
- Academic Unit
- Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Rheumatology, Allergy, and Immunology
- Record Identifier
- 9984226810602771
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